Scenario Analysis Templates by yih56082

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									  111 Query Your Way to
Measurable Patient Outcome
Diane Murphy RN, BCMA-C, Nursing ADPAC
VA Healthcare Network Syracuse, New York
         Ruth Lewellen RN, MSN
        Louisville, Kentucky VAMC
“Housekeeping & Class
     Objectives
              “Housekeeping”


• Questions
• 3x5 cards
• Web Page




                               3
                   Objectives

• Identify steps to create customized and
  canned reports using the Query Tool.
• List steps to create a customized
  report using the Query Tool in
  HealthEVet.
• Describe the Graphing tool and it's
  potential uses.
• List how the graphing tool benefits in a
  Joint Commission review
                                         4
Query Tool- What is it?
         &
   Limited Access
             Query Tool- What is it?

• Tool to Create Reports
• Software Application
• Reports for group patients
  – Based on Criteria that you Specify




                                         6
                Limited access

• Large Reports
• Data Confidentiality
• Research Considerations




                                 7
Query Tool- What is it?

       Pre-Defined

             User-Defined




                     Criteria




                                8
Why Query Tool For Nursing?




                              9
       Why Query Tool for Nursing?


       Scenario # 1 "Delay of Discharge"

Morning Report- It was reported by
 night shift that someone on 4North or
 5North discharged 10 hours after the
 physician wrote the order. It was
 mentioned that the patient was highly
 upset, but Nurse reporting this was
 passing it on to dayshift. The no one
 on duty knew who the Patient or why
 they had such a "Delay of Discharge ".

                                           10
Why Query Tool for Nursing?
Scenario # 1 "Delay of Discharge"
               Continues


       Option # 1
             Review G & L (Gains & Loss) sheet & look-up
             1 patient at a time for the 15 Patients on
             4North & 5North. Reviewing Orders and
             Notes.
             This would take some Time!


                                                       11
Why Query Tool for Nursing?
Scenario # 1 "Delay of Discharge"
       Continues

     Option # 2
           Use Query Tool-Looking at all the Discharge
           Patients for 4North & 5North and the
           following criteria:
             – Discharge Orders
             – Discharge Notes
             – Bed washing Order
         • Setup Timeline to see where the process is
           broken
         • This sounds much faster
                                                         12
Scenario # 1 "Delay of Discharge"
                        Continues


            •    Select Report
                 called "Bed
                 washing Nurse
                 Education Report"
            •    Select Patient
                 population by
                 clicking on the
                 Hyperlink



                                    13
Scenario # 1 "Delay of Discharge"
                           Continues



             •    Select the Patient
                  or Patient Group
             •    Add to Left
                  Column




                                       14
Scenario # 1 "Delay of Discharge"
                        Continues


            •    Select Orderable
                 Item




                                    15
Scenario # 1 "Delay of Discharge"
                        Continues




                                    16
Scenario # 1 "Delay of Discharge"
                        Continues




                                    17
Scenario # 1 "Delay of Discharge"
                        Continues




                                    18
Scenario # 1 "Delay of Discharge"
                          Continues




                                      19
               Restraints /Seclusion

Scenario #2
  Mr. X was in Restraints
• Was the right type of Restraints Ordered?
• If he had Med/Surg or Clinical Restraints,
  was the Patient assess prior to going into
  restraints-was that documented/
• What about 2 hour checks done?
• If in Behavioral restraints- face to face
  assessment by provider?
• Or a Debriefing Note done?


                                               20
Restraints Query




                   21
Restraints Query with Orders &
             Notes




                                 22
               Falls Documentation

Scenario # 3
Post Fall
• High Fall Risk?
• Morse Fall Scale
• Documentation of the Fall
• Reassessment of following Fall
• Does the care plan address falls?
• Transfer to another ward- Was that
  information “Handoff” to the people
  receiving that patient.

                                        23
Incomplete Orders Query




                          24
Delayed Orders Query




                       25
ADL Query




            26
Blood Transfusion with Pre-med
            Query




                             27
CAP Query




            28
DNR Query




            29
          Nursing Admission Assessment

•   Timeliness
•   Complete
•   Nurse Screen
•   Smoking Cessation Consult needed?




                                        30
Nursing Admission Query




                          31
        Why Query Tool For Nursing

• Allows Nurses to obtain Broad range
  of information in VistA/CPRS
• Review Several Records at one Time
• Review Several Performance Monitors
  at one Time
• Predefined & Custom Reports
• Evaluation of Processes
• Time & Money

                                    32
            Why Query Tool for Nursing?


• Organizational Efficiency
  – Time
  – Money
• Clinical situations




                                          33
Cost/saving Analysis




                       34
              Cost/saving Analysis

• Problem Identified
• Too Long to Log in patient’s record to
  monitor documentation
• 3 Minutes for some NM
• 5 Minutes for the other NM
• Find a way to get it done faster



                                           35
                  Cost/saving Analysis

NM                         3 Minutes      5 Minutes        Que
Review 100 charts          300 minutes    500              30
(1monitor)                                minutes
6 Monitors monthly         1800 minutes   3000             105
                                          minutes
Monthly Time               30 hours       50 hours         1.7
NM ~ $30/hr                $900/month     $1500/mont $55
Cost to monitor                           h
1NM Yearly Cost            $10,800yr      $18,000yr        $6,3
9NM Yearly Cost            $97,200yr      $162,000yr $56
Cost Saving                $40,500        $105,300
By changing to             (1350hr)       (3,510hr)
                                                      36
              Cost/Saving Analysis- NM Review 1 Monitor

                       600                                                        $300




                       500                                                        $250




                       400                                                        $200




                                                                                         Minutes to review 100 charts
                       300                                                        $150
                                                                                         Cost of NM




                       200                                                        $100




                       100                                                        $50




                          0                                                       $0
                               3 Minutes on one   5 Minutes on one
                                                                     Query Tool
                                    Chart               Chart
Minutes to review 100 charts         300                500             30
Cost of NM                          $150               $249             $15

                                                                                                                        37
                   Cost/saving Analysis


NM              3 Minutes          5 Minutes    Query Tool

Review 100     300 minutes         500 minutes 30 minutes
charts
(1monitor)
6 Monitors     1800 minutes        3000         105 minutes
monthly                            minutes
Monthly Time   30 hours            50 hours     1.75 hours
NM ~ $30/hr     $900/month         $1500/mont $550/month
Cost to monitor                    h
1NM Yearly     $10,800yr           $18,000yr    $6,300yr
Cost
9NM Yearly     $97,200yr           $162,000yr   $56,700yr
Cost
                                                       38
Cost Saving    $40,500             $105,300
                                    Nurse Manager Reviews 6 Monitors

              3500                                                         $1,600


              3000                                                         $1,400


                                                                           $1,200
              2500

                                                                           $1,000
              2000
Minutes




                                                                                    Cost
                                                                                           Minutes
                                                                           $800
                                                                                           Cost of NM
              1500
                                                                           $600

              1000
                                                                           $400

               500                                                         $200


                    0                                                      $0
                        3 Minutes on one   5 Minutes on one
                                                              Query Tool
                             Chart              Chart
          Minutes            1800               3000             105
          Cost of NM         $900              $1,500            $53


                                                                                                     39
                      Cost/saving Analysis
NM                3 Minutes           5 Minutes    Query Tool

Review 100        300 minutes         500 minutes 30 minutes
charts
(1monitor)
6 Monitors        1800 minutes        3000         105 minutes
monthly                               minutes
Monthly Time      30 hours            50 hours     1.75 hours
NM ~ $30/hr       $900/month          $1500/mont $550/month
Cost to monitor                       h
1NM Yearly        $10,800yr           $18,000yr    $6,300yr
Cost
9NM Yearly        $97,200yr           $162,000yr   $56,700yr
Cost
                                                         40
Cost Saving       $40,500             $105,300
                      Cost/saving Analysis
NM                3 Minutes           5 Minutes    Query Tool

Review 100        300 minutes         500 minutes 30 minutes
charts
(1monitor)
6 Monitors        1800 minutes        3000         105 minutes
monthly                               minutes
Monthly Time      30 hours            50 hours     1.75 hours
NM ~ $30/hr       $900/month          $1500/mont $550/month
Cost to monitor                       h
1NM Yearly        $10,800yr           $18,000yr    $6,300yr
Cost
9NM Yearly        $97,200yr           $162,000yr   $56,700yr
Cost
                                                         41
Cost Saving       $40,500             $105,300
                                 Cost/saving Analysis


               Yearly Cost Saving by Using Query


                    $180,000

                    $160,000

                    $140,000

                    $120,000

                    $100,000
                                                        Yearly no Change
                     $80,000
                                                        Yearly saving, change to Query
                     $60,000

                     $40,000

                     $20,000

                           $0
                                    3 Min     5 Min

Yearly no Change                   $97,200   $162,000
Yearly saving, change to Query     $40,500   $105,300




                                                                                         42
Types of Reports




                   43
               Types of Reports –

Pre- Defined          User-Defined
• Abnormal Results    • Custom Report
   Report
•   Consult Status
   Report
•   Incomplete
   Orders Report
•   Recent Activity
   Report
•   Schedule/Due
   Activity Report
                                        44
       Setting Up Pre-defined Reports

•   Abnormal Results Report
•   Consult Status Report
•   Incomplete Orders Report
•   Recent Activity Report
•   Schedule/Due Activity Report




                                        45
          Setting Up Pre-defined Reports

1. Click on Query Tool
2. Select the Pre-defined Report from
   the upper Panel
3. The criteria will display in lower pane
4. Criteria in blue must be defined (Click
   on the Hyperlink)
5. Criteria in Maroon has already been
   defined for you

                                           46
            Setting Up Pre-defined Reports

6. Define the List of Patients
7. Select View Reports
8. Query Tool polls the database
  •   Sensitive Patients (select or deselect)
9. Report Displays




                                                47
Abnormal Results Report

              List of Patients
                  with
                  Abnormal
                  results




                            48
Consult Status Report


          Status of consults
              for a specified
              date range




                            49
Incomplete Orders Report

        Select a particular
           status of order




                              50
Recent Activity Report


        Orders & documents
           in past 24 hours




                              51
Schedule/Due Activity Report


          Orders & Consults
             due




                               52
Setting Up User-Defined Reports




                                  53
Custom Report




                54
Custom Report




                55
Custom Report




                56
Custom Report




                57
Custom Report




                58
Custom Report




                59
Custom Report Displayed




                          60
           Setting Up User-Defined Reports

Custom Reports
• B. Miscellaneous –related to all the
  reports
    •   Printing
    •   Exporting
    •   Editing




                                         61
         . Miscellaneous –related to all the
                Reports Printing the Report

• Key ORRC QUERY
  RESULT EXPORT
  to Print Report
• Once report
  displayed-Click
  on Print




                                           62
                Setting Up Pre-defined Reports—
                      Exporting the Report



• Key ORRC QUERY
  RESULT EXPORT
  to Export this
  Report
• Once report
  displayed-Click
  on Export
• Type in name for
  exported Report
  Browse for Location
• Click Save (text
  file)                                           63
                Setting Up Pre-defined Reports—
                      Exporting the Report




• Type in name for
  exported Report
  Browse for Location
• Click Save (text
  file)




                                                  64
Import file into Excel




                         65
                   Browse for text File

• Click on Title
  of Text file
• Then Click
  open




                                          66
• Text file is
  imported
• Click Next




                 67
• You data is
  separated into
  columns
• Then Click next &
  Finish




                      68
• This box displays
• Click in the first box
  in your excel
  spreadsheet (cell)
• Then click "OK"




                           69
             Your Data Show In the Excel
                    Spreadsheet




• Be sure to save this
  as another file from
  Excel not a text file




                                           70
                  Setting Up Pre-defined Reports—
                           Editing a Report


• Can edit Both Pre-
  defined & User-defined
• In the Query Tool's
  upper Panel-Click on
  the Report you want
  edit
• Click Edit Create
  Custom Report- Search
  Items panel is display
• Edit Report as needed.



                                                    71
    Graphing for Nurses


     Diane Murphy RN
BCMA-C, Nursing ADPAC, CAC
   Syracuse, NY VAMC



                             72
                          Purpose

How To Set Your Personal Preferences

Basic Graphing For Labs

Advanced Graphing for BCMA Medications,
 Labs and Vitals

Personal Graphing Templates

Site Specific Templates


                                          73
74
The second way is
from the tools bar
(this may be site
dependant)




                     75
76
Control CTL+G
From any tab




                77
78
79
80
81
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83
84
85
Building Personal Graphing
        Templates
87
     Open Graphing
       either from tool
       bar or from labs
     Click on
         Select/Define
     1. 1. Click on
        Patient items
     2. Scroll to
        Medication
        BCMA,
     3. double click to
        move to middle,
     4. click turn blue
        then
     5. use double
        arrow to transfer
        over to Items for
#1
        Graphing
                   88
1. Go back to
Source
2. Scroll to
Vitals
3. Highlight
4. Use
double
arrows to
transfer to
Items for
Graphing

               89
1. Click on Save Personal
2. Name it.




                            90
VISN “Canned” Graphing
      Templates

  Nursing ADPAC or Clinical
 Applications Coordinator Can
             Build
To be able to save graph as a Public Graph you have to set a VISTA OR parameter
This is controlled via an OR parameter:

NAME: ORWG GRAPH PUBLIC EDITOR CLASS
 DISPLAY TEXT: CPRS Graph Public Editor Classes
 MULTIPLE VALUED: Yes                INSTANCE TERM: Sequence Number
 VALUE TERM: User Class              VALUE DATA TYPE: pointer
 VALUE DOMAIN: 8930
 VALUE HELP: Enter the User Class for public editing of graphs.
KEYWORD: GRAPHING
 INSTANCE DATA TYPE: numeric
 INSTANCE HELP: Enter a sequential number for identifying the user class.
DESCRIPTION:
This parameter contains a list of ASU user classes who's members are allowed
to edit public views and settings for graphs. Users that belong to the user
class entered at the SYSTEM level have this authority.
PRECEDENCE: 5                    ENTITY FILE: SYSTEM

******************************************************************************
Select General Parameter Tools Option: EP Edit Parameter Values
                  --- Edit Parameter Values ---

Select PARAMETER DEFINITION NAME: ORWG GRAPH PUBLIC EDITOR CLASS                  CPRS Graph
Public Editor Classes

----- Setting ORWG GRAPH PUBLIC EDITOR CLASS for System: V02.MED.VA.GOV -----
Select Sequence Number: 1

Sequence Number: 1// 1
                                                                                           92
User Class: CLINICAL COORDINATOR//
                         If you do not see Medications BCMA or Vitals as
                         a possible source. There is a VISTA parameter
                         that can be set by either your CAC or Software
                         group that will allow additional Source choices.
                         The more Sources you have may increase the
                         time that graphing loads.




Thanks to Mary Curtis!

                                                                     93
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Personal graphing templates on top


Canned site or VISN templates




                                     97
 For additional graphing
information to the CPRS

         Computerized Patient Record System (CPRS)
                        User Guide
                        GUI version
                        March 2007
http://www.va.gov/vdl/documents/Clinical/Comp_Patient_Re
       crd_Sys_(CPRS)/cprsguium.doc#_Toc155518852
                       Pages 62 to 77




                                                           98
Questions?

								
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